Towards a new vision for health: Implications for the workforce and

analysis

Anita Chandra

PFRH Seminar November 4th, 2015

Roadmap

• Context for public health-culture of health, community resilience

• Opportunities and meaning for public health research and analysis

• Opportunities for public health workforce

Culture of Health Moves a Shared Definition

Shared expectations that individual and sectors have capacity to:

• promote individual and community

well-being (as defined by physical, social, spiritual and mental health),

• create physical and social

environments that prioritize health, and

• support access to opportunities for

healthy lifestyles and quality health care for everyone.

$3 trillion

in health care expenditures annually

18% GDP

spent on health—highest in the world

$226 billion

in lost revenue due to poor health

1 in 3

children overweight or obese

1 in 5

lack easy access to healthy practices

RWJF calls to action building a Culture of

Health

New models emerge with

broader views of health

Health improvements

not fast enough

Why culture? How do we define and operationalize culture?

Define action

framework

Use measures to guide work

Develop measures

Catalyze new dialogue about health

Plan for national

integration

Change data systems and what is tracked

Culture of Health offers an action framework that can move wellbeing into local practice

What has been missing?

• Integration of the practice of government with science of wellbeing

• Coordination around a common agenda

• Consideration of local resource allocation

Culture of Health provides an action framework for consideration of other large-

scale movements

Livability Sustainability

Wellbeing Resilience

What does a “win” look like for Culture of Health

NARRATIVE: Changing national discourse on health and wellbeing (values and

priorities)

ACTION: Changing how we invest (national budget, human capital, training,

etc.)

ASSESSMENT: Changing what we measure (our approach to research, our

use of data, etc.)

11

Each action area has drivers and illustrative measures

41 measures were selected based on: • Availability of national data

• Application to entire lifespan and ‘healthspan’

• Broad determinants and upstream drivers

• Use for signal value

• Appeal to multiple audiences

• Attention to equity

Action Area 1: Making Health a Shared Value

Drivers:

• Mindset and expectations

• Sense of community

• Civic engagement

Action Area 2: Fostering Cross-Sector Collaboration to Improve Well- Being

Drivers:

• Number and quality of partnerships

• Resource investments across sectors

• Policies that support collaboration

Action Area 3: Creating Healthier, More Equitable Communities

Drivers: • Built environment and physical conditions

• Social and economic environment

• Policy and governance

Action Area 4: Strengthening Integration of Health Services and

Systems Drivers:

• Access

• Consumer experience and quality

• Balance and integration

Outcome: Improved Population Health, Well-Being, and Equity

Outcome areas:

• Improved individual and community wellbeing

• Managed chronic disease and reduced exposure to toxic stress

• Reduced health care cost

Sentinel Communities

• Opportunity to understand CoH at the local level and identify new measures using sentinel surveillance

• Mixed methods of data collection and monitoring

• 30 communities varied by geography, sociodemographics, and innovations in health

Resilience of governments

Resilience of government-NGO partnerships

Government 2.0 Government 2.0

Patient-centered medical homes, ACO

Environmental sustainability

Age friendly retirement villages

Civic well being

So how did we arrive at community resilience?

Community Resilience is Continually Developing

The ongoing and developing capacity of the community to account for its vulnerabilities and develop capabilities that aid in:

1) preventing, withstanding, and mitigating the stress of a health incident

2) recovering in a way that restores the community to a state of self-sufficiency and at least the same level of health and social functioning after a health incident

3) using knowledge from a past response to strengthen the community's ability to withstand the next health incident

Strengthening community resilience is critical in a changing world

We pursued resilience thinking when traditional disaster response models were not

enough

Resilience vs.

Preparedness

Community resilience acknowledges the intersection between individuals

and organizations

EMS

Tribal Health

Schools

Animal Services

Law Enforcement

Corrections

Faith Based

NGOs

Labs

Social Services

City Planners

Transit

Fire

Civic Groups Employers

Drug Treatment

Elected Officials

Mental Health

Health

center

Public Health Dept

Parks and Rec

Nursing Homes

Neighborhood Orgs.

Home Health

ADAPTED FROM: NACCHO (MAPP website): http://www.naccho.org/topics/infrastructure/MAPP/index.cfm

Community resilience requires building neighbor to neighbor reliance and organizational connection

Individuals/families have the knowledge to prepare for and respond to disaster

There are enough volunteers to help in a disaster

Organizations are ready and prepared to respond and recover

There are strong relationships between organizations

People can rely on each other (neighbor to neighbor)

RESILIENT COMMUNITIES RESILIENT COMMUNITIES

Resilient communities drive residents towards a resilience mindset

Community Resilience Mindset

Community resilience has represented the intersection of Community Health Promotion and Emergency Preparedness

Community Health Promotion

Community Resilience Emergency

Preparedness

Routine surveillance Assessment of population, structural vulnerabilities and assets

Emergency risk assessment

Community education Education about ongoing mitigation

Risk communication

Provision of direct health services (e.g., immunizations, home visiting)

Ongoing assurance of health service access; skill building (e.g., PFA)

Provision of shelters, evacuation plans, mass prophylaxis

Policy support re: health impact

Policies that prepare for routine and emergency conditions

Policy support re: disaster response and recovery

Implications for public health research and analysis

New movements require a more nuanced understanding of stakeholders

• Whole of community is intrinsic to planning, strategy

• New and unique partnerships required for public health to advance mission

Question: Do our models of partnership and collaboration work? Where has CPBR, etc.

worked and where has it not?

Research requires new ways of thinking about data regimes and systems

• Government 2.0, Web 3.0

• Integration of data systems

Questions: What constitutes public health data?

How are data systems being used for ongoing adaptive capacity?

These frameworks require consideration of people and planet together

• Intersection of social and natural sciences; infrastructure and human

• Social change theory is central

Question:

What models fully incorporate these disciplines and systems, and where does PH fit?

Frameworks also require reconsideration of government, public-private roles

• Government role as safety net, or promoter of wellbeing

• Which P3 models will work to advance and sustain this orientation to health

Question: Where should public health departments position

themselves in resilience strengthening or advancing culture of health?

Implications for workforce, capacity building

Public health curriculum should consider use of narrative

• Advancing movements for transformation require new approaches to dialogue

Question: How do we train on the use of

narrative in current programs? Where is that in core competencies?

Workforce will need to understand processes of collaboration

• Training in the development, sequencing and maintenance of collaboration

• Tools in how to advance ideas in competing and contentious contexts

Rigor in conceptual broadness or “messiness” needs to be practiced and

discussed

• Blending disciplines and sectors means rough edges…at times

• Skill in deconstructing broad concepts and linking ideas and pathways

Getting inside processes of change means some skill in…

• Decision analyses

• Use of networks

• Understanding of distributed knowledge pathways

• Use of technology

• Social and political context